Dr. Jared Maloff

The Importance of Differential Diagnosis

jared — Sun, 13 Feb 2011 17:32:26 +0000

Here is an article that I found today on AOL. It brings up a very important point which is that ADHD is most likely overdiagnosed in this country. It is a disorder that shares overlapping symptoms with other diagnoses which reinforces how important appropriate, expert diagnosis is when assessing one’s symptoms. Especially when dealing with children and the prospect of using medications, it is incredibly important to get the diagnosis right! This article highlights this point:

Nearly 10 percent of children and 4 percent of adults in the U.S. have been diagnosed with ADHD. But studies suggest that while many people with ADHD still go undiagnosed, others are wrongly diagnosed with ADHD when they are instead suffering from a range of other disorders. The most common cause of misdiagnosis is a misunderstanding of what ADHD really is, according to Dr. Russell Barkley, clinical professor of psychiatry at the Medical University of South Carolina and author of “Taking Charge of ADHD: the Complete, Authoritative Guide for Parents.” “People rather superficially see that someone has difficulty paying attention and think they may have ADHD,” he says. “But the differential diagnosis of ADHD is not based on inattention — it’s based on the other deficits that go along with inattention: lack of self control, heedlessness, recklessness, thoughtlessness, an inability to think of what you’re doing before you do it.” So which conditions are most often mistaken for ADHD, and how can such misdiagnoses be avoided?Autism
“ADHD is rarely misdiagnosed as autism, but sometimes autism can be misdiagnosed as ADHD in its early stages,” says Barkley. That’s because the two conditions overlap, according to studies. Forty percent of autistic children have ADHD, and a portion of ADHD children have some autistic traits. Parents and practitioners often pick up on one condition but not the other. Barkley cautions parents and doctors to look for the signs of autism. Children with autism are not merely inattentive: They may have problems with language, stand too close to others, find social situations awkward or completely uninteresting, be unable to make eye contact, or engage in behaviors like hand flapping.

Bipolar Disorder
ADHD symptoms are present in people suffering from bipolar disorder, especially during the manic phase of the illness. “Don’t focus on ADHD symptoms because the ADHD symptoms are present,” says Barkley, referring to the ADHD triad of inattention, hyperactivity and impulsiveness — all of which emerge when a person with bipolar disorder has a manic episode. “Instead, focus on emotional and social symptoms of manic episodes.” These symptoms, which are unique to bipolar disorder, include elation, grandiosity, sleeplessness and an extremely positive mood state, followed by a crash during which the person is irritable, depressed, withdrawn and explosive for hours or days.

The age of onset also determines the diagnosis, since symptoms of bipolar disorder usually emerge when a person is in late adolescence or early adulthood, while ADHD’s onset is in childhood. That said, there’s a significant overlap of the two. A 2003 study at Massachusetts General Hospital of 51 adult ADHD patients found that 24 of the patients also had bipolar disorder. According to Barkley, the earlier the onset of bipolar disorder, the more likely that it will be accompanied by ADHD: “If bipolar disorder starts in adulthood, only 20 to 25 percent of people will have ADHD with it,” says Barkley. “If the bipolar disorder starts during teenage years, 45 to 50 percent have ADHD along with that bipolar disorder. And if your bipolar starts in childhood, 80 to 97 percent of those cases will have ADHD with it.”

The CDC Reports a 22% Rise in ADHD

jared — Thu, 02 Dec 2010 06:18:01 +0000

Just before Thanksgiving a report was released by the CDC claiming that between 2003 and 2007 the prevalence of ADHD in children jumped a startling 22% and that now 1 in 10 children have ADHD! The media sensationalized the story most likely adding to parent’s fears throughout the country who may now be more likely to pathologize behavior in their children that is actually within the normal range.

As a practitioner with expertise in assessing ADHD, learning disabilities and other disorders usually associated with childhood misbehavior and underachievement, I believe that the report of this large increase of ADHD in children is false. What the 22% increase actually means is that when people were polled by the CDC and asked if their child has been diagnosed with ADHD, 22% more parents indicated that they had. To me, this is another example of how easy it is to misdiagnose ADHD.

The diagnosis of ADHD is actually tricky though it often seems quite simple to laypeople given the huge amount of press coverage this disorder gets. Most people seem to believe that if their child is hyperactive, misbehaves, underachieves in school, or is forgetful, they have ADHD. Compounding the problem is that many professionals in the medical and mental health fields share the same beliefs, and are more likely to make a diagnosis of ADHD when dealing with zealous parents seeking an explanation for their children’s perceived shortcomings.

Part of being a good parent is believing that your child is capable of being a straight A student, well rounded, likeable, and perfectly behaved, but even parents with the best of intentions must be aware that a departure from these virtues, momentarily or otherwise, do not necessarily suggest pathology. Many parents cling to the ADHD label because this is a disorder that can be effectively medicated and in essence, “fixed”. The reality is that the qualities of ADHD overlap greatly with many kinds of learning disabilities (which cannot be treated with medication), mood disorders (which require therapy and a different class of medications), behavioral disorders (which may be made worse by stimulant medication), and the simple, normal range of human behaviors.

There is no doubt that ADHD is over-diagnosed, and this fact only serves to diminish the difficulties that people who actually have ADHD experience. The overlapping nature of many ADHD symptoms with other diagnoses makes procuring a proper ADHD assessment essential to the diagnostic process. This assessment should be conducted by a qualified professional and should include a review of life history, educational history, medical history, and the administration of a battery of tests including a cognitive measure, an achievement measure and an assessment of memory.

As a psychologist who frequently administers these tests I can say that there are many times that a patient seems like they have ADHD, but when tested it becomes clear that there is something entirely different occurring. Objective testing measures need to be sought out and utilized by parents more frequently in order to ensure that their children are receiving appropriate diagnoses which would eliminate the risk of being needlessly, or inappropriately medicated. More knowledgeable parents and practitioners about this issue will undoubtedly lead to more effective treatment of a variety of mental health issues.

Jared Maloff Psy.D.

(310) 712-5480

New Study Suggests a Cause for ADHD

jared — Tue, 18 May 2010 04:50:08 +0000

The following is an article from health.com:

Children exposed to higher levels of a type of pesticide found in trace amounts on commercially grown fruit and vegetables are more likely to have attention deficit hyperactivity disorder (ADHD) than children with less exposure, a nationwide study suggests.

Researchers measured the levels of pesticide byproducts in the urine of 1,139 children from across the United States. Children with above-average levels of one common byproduct had roughly twice the odds of being diagnosed with ADHD, according to the study, which appears in the journal Pediatrics.

Exposure to the pesticides, known as organophosphates, has been linked to behavioral and cognitive problems in children in the past, but previous studies have focused on communities of farm workers and other high-risk populations. This study is the first to examine the effects of exposure in the population at large.

Organophosphates are “designed” to have toxic effects on the nervous system, says the lead author of the study, Maryse Bouchard, PhD, a researcher in the department of environmental and occupational health at the University of Montreal. “That’s how they kill pests.”

The pesticides act on a set of brain chemicals closely related to those involved in ADHD, Bouchard explains, “so it seems plausible that exposure to organophosphates could be associated with ADHD-like symptoms.”

Environmental Protection Agency (EPA) regulations have eliminated most residential uses for the pesticides (including lawn care and termite extermination), so the largest source of exposure for children is believed to be food, especially commercially grown produce. Adults are exposed to the pesticides as well, but young children appear to be especially sensitive to them, the researchers say.

Detectable levels of pesticides are present in a large number of fruits and vegetables sold in the U.S., according to a 2008 report from the U.S. Department of Agriculture (USDA) cited in the study. In a representative sample of produce tested by the agency, 28% of frozen blueberries, 20% of celery, and 25% of strawberries contained traces of one type of organophosphate. Other types of organophosphates were found in 27% of green beans, 17% of peaches, and 8% of broccoli.

Although kids should not stop eating fruits and vegetables, buying organic or local produce whenever possible is a good idea, says Bouchard.

“Organic fruits and vegetables contain much less pesticides, so I would certainly advise getting those for children,” she says. “National surveys have also shown that fruits and vegetables from farmers’ markets contain less pesticides even if they’re not organic. If you can buy local and from farmers’ markets, that’s a good way to go.”

A direct cause-and-effect link between pesticides and ADHD “is really hard to establish,” says Dana Boyd Barr, PhD, a professor of environmental and occupational health at Emory University. However, she says, “There appears to be some relation between organophosphate pesticide exposure and the development of ADHD.”

This is the largest study of its kind to date, according to Barr, who researched pesticides for more than 20 years in her previous job with the Centers for Disease Control and Prevention (CDC) but was not involved in the study.

Bouchard and her colleagues analyzed urine samples from children ages 8 to 15. The samples were collected during an annual, nationwide survey conducted by the CDC, known as the National Health and Nutrition Examination Survey.

The researchers tested the samples for six chemical byproducts (known as metabolites) that result when the body breaks down more than 28 different pesticides. Nearly 95% of the children had at least one byproduct detected in their urine.

Just over 10% of the children in the study were diagnosed with ADHD. The kids were judged to have ADHD if their symptoms (as reported by parents) met established criteria for the disorder, or if they had taken ADHD medication regularly in the previous year.

One group of pesticide byproducts was associated with a substantially increased risk of ADHD. Compared to kids who had the lowest levels, the kids whose levels were 10 times higher were 55% more likely to have ADHD. (Another group of byproducts did not appear to be linked to the disorder.)

In addition, children with higher-than-average levels of the most commonly detected byproduct—found in roughly 6 in 10 kids—were nearly twice as likely to have ADHD.

“It’s not a small effect,” says Bouchard. “This is 100% more risk.”

To isolate the effect of the pesticide exposure on ADHD symptoms, the researchers controlled for a variety of health and demographic factors that could have skewed the results.

Still, the study had some limitations and is not definitive, Bouchard says. Most notably, she and her colleagues measured only one urine sample for each child, and therefore weren’t able to track whether the levels of pesticide byproducts were constant, or whether the association between exposure and ADHD changed over time.

Long-term studies including multiple urine samples from the same children are needed, Bouchard says. She suspects such studies would show an even stronger link between pesticide byproducts and ADHD.

EPA spokesman Dale Kemery said in a statement that the agency routinely reviews the safety of all pesticides, including organophosphates. “We are currently developing a framework to incorporate data from studies similar to this one into our risk assessment,” Kemery said. “We will look at this study and use the framework to decide how it fits into our overall risk assessment.”

Kemery recommended that parents try other pest-control tactics before resorting to pesticide use in the home or garden. Washing and peeling fruits and vegetables and eating “a varied diet” will also help reduce potential exposure to pesticides, he said.

“I would hope that this study raises awareness as to the risk associated with pesticide exposure,” Bouchard says. “There’s really only a handful of studies on this subject out there, so there’s room for more awareness.”

Wall St Journal Article on Adult ADHD

jared — Wed, 07 Apr 2010 04:38:12 +0000

The symptoms of adult attention-deficit hyperactivity disorder seem to describe half the people in New York City: restlessness, impatience, impulsivity, procrastination, chronic lateness, and difficulty getting organized, focusing and finishing tasks.

How do you know you have ADHD, which experts compare to having a mind like a pinball, with thoughts flitting in multiple directions. Maybe you’re just overcaffeinated and overworked? And if you do have it, will there be a stigma? Should you try medication? Will it work?

Parents of children with suspected ADHD face a myriad of similar questions. But the concerns can be just as troubling for adults, whose ADHD often goes unrecognized.

An estimated 8% of U.S. children have ADHD, which is also known as ADD, for attention-deficit disorder, and some 50% of them outgrow it, according to government data. About 4.4% of U.S. adults—some 10 million people—also have ADHD and less than one-quarter of them are aware of it.

That’s because while ADHD always starts in childhood, according to official diagnostic criteria, many adults with the disorder went unnoticed when they were young. And it’s only been since the 1980s that therapists even recognized the disorder could persist in adults.

Even now, getting an accurate diagnosis is tricky. Some experts think that too many adults—and children—are being put on medications for ADHD, often by doctors with little experience with the disorder. Others think that many more people could benefit from ADHD drugs and behavioral therapy.

Photo Illustration by WSJ

10 Million

Estimated number of U.S. adults, or 4.4% of the adult population, that have ADHD. Less than one-quarter of them are aware they have the condition.

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Complicating the picture further, ADHD frequently goes hand in hand with depression, anxiety and bipolar disorder, and it can be difficult to untangle which came first. “It’s very common for someone to be treated for depression or anxiety for years, and have the therapist not notice the ADHD,” says Mary Solanto, director of the AD/HD Center at the Mount Sinai Medical Center in New York City. But adults whose ADHD is left untreated face a high incidence of substance abuse, automobile accidents, difficultly staying employed and maintaining relationships.

That said, some adults with ADHD are highly intelligent, energetic, charismatic and creative, and are able to focus intently on a narrow range of topics that interest them. David Neeleman, the founder of JetBlue Airways, and Paul Orfalea, founder of Kinko’s, have spoken out about how the disorder helped them come up with innovative ideas for their corporations, despite their having done poorly in school.

“It’s amazing how successful some people are able to be despite these symptoms, and some people are totally paralyzed—there’s a whole spectrum of outcomes,” says Ivan K. Goldberg, a psychiatrist in New York City who co-developed a commonly used screening test.

Generally, ADHD can make life very difficult. It’s thought to be an imbalance in neurotransmitters, the chemical messengers that relay signals in the brain, particularly in the frontal cortex that governs planning and impulse control. Children with the disorder, particularly boys, are likely to be hyperactive, with an intense need to move constantly, which can interfere with learning. (Girls tend to be talkative and dreamy, but they are often overlooked because they aren’t as disruptive.)

Adults more typically have trouble with paying attention, focusing and prioritizing. Managing time and money are particularly difficult.

“What it really is is a disturbance of the executive functions of the brain — it’s the inability to plan things, to initiate them at the appropriate time, not to skip any of the steps and to terminate them at the appropriate time,” says Dr. Goldberg. “An awful lot of these people are very bright but they can’t keep it together. They keep screwing things up.”

“It’s extremely hard for me to sit my butt in a chair. I get fidgety. I want to get up,” says Linda Hensens, 46, a medical transcriptionist in Clayton, N.C., who discovered she has ADHD when a bariatric surgeon asked about her working habits. “I’ll think of the wash that needs to be done and clothes that need to be folded and dusting that needs to be done and, Oh my god, I promised my nephew I’d make a cheese cake, and I’ve got Easter dinner to plan. My mind is going like that all the time.”

Some people with ADHD are able to compensate for their distractibility, at least for a while. Some excel in school early on but run into problems once they get to college or get a job where they have to stay organized on their own.

“I see adults with ADHD who are in medical and law school or running companies, and at some point, they hit a ceiling. Their coping mechanisms aren’t effective anymore,” says Peter Jaksa, a clinical psychologist who works with ADHD patients in Chicago.

Dr. Jaksa says he recognized the symptoms of ADHD in himself long after graduate school when he was working with underachieving kids. “Once you know what it is, things make sense that didn’t make sense previously,” he says, such as his pattern of writing every paper in college the night before it was due, with a six-pack of Dr. Pepper and a bottle of No-Doz.

“We see people from all of the professions who have managed to succeed despite the limitations, but they have often done it at significant cost,” says Dr. Solanto. “They don’t have time to enjoy life. They don’t get their work done in the course of a day. They have to stay late after hours, or they are doing without sleep, frantically trying to meet deadlines. It ultimately takes a toll on their wellbeing and a toll on the people around them.”

Do You Have Adult ADHD?

Take a screening test.

More interactive graphics and photos

ADHD Resources

CHADD.org — Children and Adults with Attention Deficit/Hyperactivity Disorder, a national non-profit education and advocacy group
ADD.org — National Attention Deficit Disorder Association
Additudemag.com — ADDitude magazine
ADDCenters.com — Peter Jaksa’s clinical practice

Reading List

“Driven to Distraction: Recognizing and Coping With Attention Deficit Disorder from Childhood Through Adulthood,” by Edward M. Hallowell, M.D., and John J. Ratey, M.D.
“The Disorganized Mind: Coaching Your ADHD Brain to Take Control of Your Time, Tasks and Talents” by Nancy Ratey
“The Everything Health Guide to Adult ADD/ADHD” by Carole Jacobs and Isadore Wendel
“Is It You, Me, or Adult A.D.D.” by Gina Pera
“Copy This!: Lessons from a Hyperactive Dyslexic Who Turned a Bright Idea Into One of America’s Best Companies,” by Paul Orfalea

While that sounds like many people who are simply driven or trying to do too much in an uncertain economy, experts say it may be ADHD when it interferes with the basics of life. “The magic word is impairment,” says Dr. Jaksa. “Everyone gets distracted. Who’s not late occasionally? But if you are chronically late, you lose your job and maybe your friends as well.”

“I was a textbook case,” says Ali Bauman, a 38-year-old writer in Chicago. “I had a messy bedroom and a string of minor car accidents that I could never explain. I couldn’t keep the house clean, pay bills, get things done on time. It wasn’t that I didn’t want to do it, I just wasn’t capable of doing it.”

As with other psychiatric conditions, there is no blood test or brain scan that can diagnose ADHD. Experts say people who suspect they have it should have a thorough evaluation, ideally with a psychologist or psychiatrist who specializes in the disorder, looking at how they functioned in early childhood, in school and social settings and personal relationships. A screening test can help determine if you should see a mental-health professional, but shouldn’t be used for diagnosis.

Once ADHD is diagnosed, most experts recommend treatment with both medication and behavioral therapy.

As counterintuitive as it may seem to give stimulants to people who can’t sit down, drugs such as Ritalin, Adderall, Concerta and Vyvanse increase neurotransmitters in parts of the brain that help people focus and control impulses. “They wake up the parts of the brain that are sluggish, so they regulate the brain at a more normal level,” Dr. Jaksa says.

There are some concerns that stimulant medications can be abused by people who don’t need them. Dr. Goldberg notes that drugs for ADHD can make anybody focus better. But for people with true ADHD, they bring significantly more mental clarity. “My brain felt like it was screwed on more tightly. Everything came into focus. I could be active and do things with my life,” Ms. Bauman says.

There also have been concerns that such medications could make some people with ADHD lose their creative edge. But, says Dr. Jaksa, “In my experience, that only happens when the dosage is too high, or it’s not the right medicine.” He also recommends at least 30 minutes a day of vigorous exercise, which can also increase neurotransmitters.

While medication can help ADHD sufferers focus better, behavioral therapy can teach them what to focus on, how to schedule their lives and set priorities.

Dr. Solanto developed a 12-week program to help people with ADHD learn to manage time, break down daunting tasks into manageable steps and keep themselves organized. One mantra of the program is: “If it’s not in the planner, it doesn’t exist,” says Dr. Solanto. In a study of 88 patients published last month in the American Journal of Psychiatry, they found that those who participated in the program improved significantly more than those who received more standard supportive therapy.

ADHD coaching services provide some of the same lessons, for anywhere from $60 to $300 an hour. “People contact me when they’re sick of themselves. They keep repeating the same patterns and can’t get a grip on how to change it,” says Nancy Ratey, a Boston-based coach who has ADHD herself. She designs individual strategies to help clients meet their responsibilities, which could run the gamut from hiring an administrative assistant to programming their cellphones to ring every hour to make sure they are staying on schedule. “There’s nothing worse than an ADHD boss,” who keeps saying “this is urgent,” “no, this is urgent,” she says.

Many ADHD sufferers learn their own tricks to stay organized.

“I buy socks in only one color so I don’t confuse them,” says Ms. Bauman. “I use one purse a week and my keys stay in there.” And because she gets overwhelmed wandering around the grocery store, Ms. Bauman says she’s begun ordering groceries online to save time.

Besides learning such organizing skills, many people with ADHD say the biggest challenge is learning not to let the disorder erode their self-confidence, and not to blame themselves for shortcomings.

“There’s a huge incidence of depression with ADHD because you are continually failing in the eyes of others, not reaching your potential. People recognize you are smart, and you can’t find your niche,” says Rob Cahill, 38, an ADHD sufferer who works in social service agency in New York.

Still, Mr. Cahill says that understanding his disorder has helped him empathize with the social-service clients he serves. “The ADHD is a gift in some ways, it’s just sometimes hard to recognize.”

ADHD in the News

jared — Fri, 12 Feb 2010 10:13:47 +0000

As I have written about here before, I do extensive work assessing for and diagnosing ADHD. One area I have particularly focused upon is Adult ADHD which normally gets far less media coverage than childhood ADHD. I thought it was interesting therefore that on msn.com an article was posted seemingly in the spirit of Valentine’s Day, yet focused upon the relational aspect of being married to a partner with ADHD. It is an interesting take for the partner of an adult with ADHD to write of her experiences with the diagnosis through the relationship she has with her husband. The article can be found at: http://health.msn.com/health-topics/adhd/adult/articlepage.aspx?cp-documentid=100253978&gt1=31001

Enjoy,

Dr. Jared Maloff

(310) 712-5480

New Addition!

jared — Wed, 10 Feb 2010 07:07:03 +0000

I want to announce a new addition to my practice, and let everyone know that now my office can conduct psychological and psychoeducational testing in Spanish as well as English. I am excited about this new development as we now have the capacity to assess for a wide variety of educational, developmental and psychological issues between the ages of 2 and 102! This new addition will enable us to broaden the scope of our services while still providing quality care for myriad issues that can arise throughout the life span.

Dr. Maloff

(310) 712-5480

Testing Accommodations

jared — Sat, 23 Jan 2010 09:34:23 +0000

Testing Accommodations

As the nation’s economy continues to struggle to create job growth, more and more American adults are returning to school. In these economic times, earning a college degree no longer ensures that a good job is soon waiting on the horizon. Obtaining graduate level degrees is more important than ever to help secure one’s future in the workforce. This cultural shift is definitely being evidenced within my practice. I devote approximately 50 percent of my time to conducting therapy and 50 percent of my time conducting psychological and psychoeducational testing. More people than ever are now contacting me to attempt to qualify for testing accommodations on exams such as the LSAT, MCAT, GMAT, GRE and DAT. The ages of these clients seems to be trending older as more and more people who have lost their jobs, or have failed to find good jobs straight out of college, are needing to succeed on these ever more competitive tests that essentially serve as entrance exams to law school, business school, medical school and dental school.

Some believe that testing accommodations unfairly skew results in favor of those who obtain them, thus leaving those who do not have accommodations at a major disadvantage. The reality however is much different. Those with disabilties (i.e. learning disabilities, ADHD) are negatively impacted in academic situations, standardized testing situations and other major domains of life such as work and interpersonal relationships. By definition a disability places the suffering individual at such a disadvantage over non-disabled individuals that accommodations such as extended time, private room testing, extended breaks between sections and paper and pencil exam forms are essential in order to ‘level the playing field’. The Americans With Disabilities Act of 1990 protects ALL people with disabilities not just from discrimination in society and at work but ALSO on standardized tests such as the SAT, LSAT, GMAT, MCAT, and the Bar Exam.

Most laypeople think of the disabilities as a set of symptoms that can easily be seen and identified. The insignia representing the notion of a disability even depicts a person in a wheelchair, but psychiatric diagnoses and psychoeducational diagnoses DO qualify as serious disabilities that are protected by the Americans with Disabilities Act. Though ADHD and learning disabilities are not readily apparent to the average observer, their symptoms can be extremely difficult for the sufferer to manage. Standardized testing exacerbates the impact of these diagnoses rendering those with these diagnoses at significant disadvantages.

In order to apply for testing accommodations, a diagnosis from a doctor past or present is not by itself enough to qualify. Even receiving accommodations in the past does not ensure a successful petition for testing accommodations. In order to qualify one must be tested by a qualified professional with experience in testing accommodations. On average, a comprehensive report is 15-20 pages long not including educational and clinical records. Such reports must fully explain the testing results as well as provide clear rationale for the necessity of current accommodations on a specific exam. For someone with ADHD or learning disability, testing accommodations can make an enormous difference in scoring which of course aids admission to higher quality schools.

With more people than ever returning to school, entrance to graduate programs has become even more competitive than in the recent past. With this trend continuing, those who suspect they may have diagnoses such as ADHD or a learning disability should not hesitate to be assessed by a qualified professional as admission to graduate school is now more than ever an important stepping stone on the path to success.

Dr. Jared Maloff

(310) 712-5480

www.BeverlyHillsPsychologist.com

50 Percent Increase in Autism in Past 2 years? Think Again.

jared — Thu, 22 Oct 2009 23:02:32 +0000

In today’s L.A. Times an article ran that advertised what seems to be a disturbing trend. According to the CDC the proportion of 8 year olds diagnosed with an Autism Spectrum Disorder has increased 50% in the past 2 years. Essentially this means that previously 1/150 children were diagnosed with the disorder while currently that number has increased to 1/100. Even more startling is the fact that 1/58 boys are now diagnosed with an Autism Spectrum Disorder. This is truly a staggering number.

Autism Spectrum Disorders refer to Autism and Asperger’s Syndrome which some researchers believe to be a milder form of Autism. In my clinical practice however, it is my belief that Asperger’s is a seperate entity from Autism. There are similarities in the two disorders but Asperger’s also has a lot in common with another highly diagnosed condition amongst boys; ADHD. Rather than believe that 8 year olds of 2009 are 50% more likely to be Autistic than in 2007, the research merely indicates that the diagnosis of Autism and Asperger’s Syndrome are being levied much more frequently.

For properly trained psychologists who understand child development Autism is hard to miss. It is estimated that around half of Autistic children are also mentally retarded. Also, Autistic children do not meet the developmental milestone of talking on time. Some are never able to communicate verbally at all. For those who can verbalize and are not mentally retarded, the tell tale signs of Autism are severe delays in speech as well as disinterest and inability to functionally participate in social relationships. Asperger’s is a bit harder to spot because this diagnosis is NOT co-morbid with mental retardation or major problems in speech. Instead the diagnostic criteria is mainly based upon difficulties with social relationships, immaturity, rigidity, concrete thinking and difficulty taking on anyone else’s perspective but their own. These criteria are much more subjective and the symptoms sound general. If one were to just use these symptoms alone to make their diagnosis, many of our friends and acquaintances would be labelled with this syndrome inaccurately.

Unless a psychologist has experience with assessing these kinds of disturbances in child development they should not be offering such diagnoses. Autism and Asperger’s are life-long developmental disabilities and their diagnosis carries a great deal of weight. Just because the media is covering these issues more as of late does not qualify all mental health practitioners to diagnose these disorders. This is why we end up with these inflated numbers that are sure to scare all perspective parents. It is my belief that children are being diagnosed with Asperger’s Syndrome when they actually may have other diagnoses that share some similar symptoms. ADHD and Oppositional Defiant Disorder are two other commonly diagnosed disorders of childhood that may now be getting labelled as Asperger’s by clinicians who have Asperger’s on the brain more than ever due to enhanced media coverage.

Due to the severity of Autism and Asperger’s diagnoses I would encourage all parents who have doubts about their child’s diagnosis to seek at least a second opinion from a clinical psychologist who specializes in assessment and is highly familar with these disorders. If everyone sought such second opinions I am certain that the rapid increase in these diagnoses over the past 2 years would be discovered to be spurious.

Dr. Jared Maloff

(310) 712-5480

Adult ADHD

jared — Thu, 30 Jul 2009 20:04:07 +0000

There is a myth that is quite prevalent among both laypeople as well as mental health professionals that ADHD is primarily a disorder of childhood. While the diagnosis is generally made in childhood and symptoms first begin to develop prior to age 7, ADHD is a pervasive psychobiological disorder that people experience into adulthood. While many adults figure out how to manage their symptoms in such a manner so as to minimize the negative impact upon their life, others cannot either due to the severity of the disorder, or their lack of treatment.

My practice is 33% comprised of clients with Adult ADHD, and approximately 75 percent of calls from new clients are those seeking treatment for this diagnosis. I believe that as society evolves and technology becomes more and more easily accessible, it becomes ever more difficult to live with Adult ADHD. There seem to be far too many distractions available for those already prone to inattentiveness. The days of unplugging the TV in order to focus on work are over because now one would have to remove themselves from their computers and phones as well in order to eliminate distraction, something we as a society all seem loathe to do. We live in an age of immediacy where the expectation is to be entertained at every free moment. This value will only exacerbate the symptoms of ADHD and make it even harder for those with this diagnosis to calm their hyperactive, sensory seeking behavior.

Due to economic factors adults who previously who have not been interested in returning to school are doing so and finding difficulties sitting through long lectures attentively. Even those adults with ADHD who had been able to find a career that they could manage given their symptoms are feeling like kids again as they realize their symptoms may not be as under control as they had believed. Due to these societal factors of the convergence of high technology within this period of economic turmoil, I believe more adults will be diagnosed with ADHD than ever before as they switch careers or return to school.

Adults who experience symptoms such as forgetfulness, disorganization, losing or misplacing important things, feel the need to be constantly entertained and stimulated, lose their place while reading, tune out others who are speaking to them, or feel fidgety may have ADHD. Though this diagnosis can range between milder and more severe cases, it is important to seek treatment in order to learn the most effective methods of managing their symptoms.

Dr. Jared Maloff

(310) 712-5480

New Year’s Resolutions

jared — Sun, 04 Jan 2009 00:09:55 +0000

40 to 45% of American adults make one or more New Year’s resolutions. Studies have shown that the most common things we want to change about ourselves are: lose weight, exercise more, stop smoking, save more money , and get out of debt.

The following shows how many of these resolutions are maintained as time goes on:
- past the first week: 75%
- past 2 weeks: 71%
- after one month: 64%
- after 6 months: 46%

While a lot of people who make new years resolutions do break them, research shows that making resolutions is useful. People who choose to explicitly make a resolution and tell others about it are 10 times more likely to follow through than people who keep their goals to themselves, and don’t officially give it the “New Year’s Resolution” label.

As with all goal setting, telling important people in our lives about it, and writing the goal down are important because it makes us feel accountable. These small acts instill a feeling that the goal is now bigger than just ourselves, and enhances the possibility of following through over the long term.

Another aspect of goal setting that has been known to lead toward ultimate follow through is specificity. For instance, if a person wants to lose weight, they should identify the amount of weight they want to lose, thus making the goal concrete. While concretizing the goal, another equally crucial part of the plan is moderation. Someone who wants to lose 20 lbs, or get out of debt should NOT strive to complete these tasks in a short period of time. The pressure of restricting spending to the bare minimum to get out debt quicker will ultimately make the task overbearing and impossible to keep up over the long haul. Same with weight loss. Losing all the weight one needs to lose in a month is unrealistic and would involve a far too restricted diet to be able to continue past the 6 month milestone where a full 54 percent of us abandon our resolutions. The same even goes for stopping smoking. This is probably the hardest of the most common resolutions to follow through on. While ‘cold turkey’ works for some people, I recommend a plan of moderation here as well. Learning to reduce the amount of cigarrettes week by week to eventually get down to none is a very slow but steady manner of stopping. Also using the nicotine patches and even talking to one’s doctor about medication options to stop smoking will make the goal much more managable. Also, many people who smoke do so to reduce stress, and oftentimes addressing one’s underlying depression with therapy can help reduce thisstress ina non-destructive manner. This can also aid one to stop smoking in 2009.

Setting moderate, even easy to accomplish goals for the first 6 months of ’09 will help enable us to get into a routine of success where we know we can accomplish our goals, and furthermore, EXPECT to accomplish our goals. Learning to expect success, and making our goals do-able and realistic can help ensure that in 2010, we aren’t making the exact same resolutions of 2009.

Dr. Jared Maloff

(310) 712-5480